We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
- Negotiates, executes, conducts high level review and analysis of dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers including but not limited to individual and group behavioral health providers, etc. in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.
- Recruit providers as needed to ensure attainment of network expansion goals, achieve regulatory and/or internal adequacy targets.
- Support health plan with expansion initiatives or other contracting activities as needed
- Initiates, coordinates and owns contracting activities to fulfillment including receipt and processing of contracts and documentation and pre- and post-signature review of contracts and language modification according to Aetna’s established policies.
- Responsible for auditing, building, and loading contracts, agreements, amendments, and/or fee schedules in contract management systems per Aetna established policies.
- Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
- Provides Subject Matter Expertise for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained.
- Understanding of Value-Based contracting and negotiations.
- Preparing reports and presenting to Network Management leadership
- Engage with providers and move quickly through contracting processes to ensure network adequacy standards are met.
Required Qualifications
- 5+ years of healthcare experience in network contracting and provider relationship management.
- 3-5 years of solid negotiating and complex decision-making skills while executing national, regional, or market level strategies.
- Demonstrated knowledge of the managed care industry, including reimbursement models, regulatory requirements, and contracting best practices.
- Working knowledge of behavioral health topics related to managed care plans.
- Advanced proficiency in Microsoft Office Suite, particularly Excel (e.g., data analysis, modeling, reporting) and PowerPoint (e.g., executive presentations).
- Proven ability to build and maintain collaborative provider relationships and partner cross-functionally to resolve complex contract or network issues, with examples of successful issue resolution or stakeholder alignment.
- Candidates must reside in PA, DE, NY, NJ, MD, or Washington, DC
Preferred Qualifications
- Health plan experience supporting behavioral health provider networks.
- General knowledge of reporting tools for contract financial analysis and modeling.
- Demonstrated decision-making skills while executing national, regional and market level strategies.
- Possess critical thinking, issue resolution and interpersonal skills.
- Strong critical thinking and problem-solving abilities, with a track record of resolving complex issues and driving effective solutions.
- Excellent interpersonal and communication skills, including the ability to clearly convey complex information both verbally and in writing to diverse stakeholders.
Education
- Bachelor's degree or equivalent professional work experience.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$66,330.00 - $145,860.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 5+ years of healthcare experience in network contracting and provider relationship management.
- 3-5 years of negotiating and complex decision-making skills while executing national, regional, or market level strategies.
- Demonstrated knowledge of the managed care industry, including reimbursement models, regulatory requirements, and contracting best practices.
- Working knowledge of behavioral health topics related to managed care plans.
- Understanding of Value-Based contracting and negotiations.
- Advanced proficiency in Microsoft Office Suite, particularly Excel and PowerPoint.
- Proven ability to build and maintain collaborative provider relationships and partner cross-functionally to resolve complex contract or network issues.
- Candidates must reside in PA, DE, NY, NJ, MD, or Washington, DC.
- Bachelor's degree or equivalent professional work experience.
- Health plan experience supporting behavioral health provider networks.
- General knowledge of reporting tools for contract financial analysis and modeling.
- Demonstrated decision-making skills while executing national, regional and market level strategies (preferred reinforcement of negotiating capability).
- Strong critical thinking, problem-solving, interpersonal and communication skills.
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
